Missed Punch Form
As an employee of ShiftMed, please fill out this form only if you have worked a shift that requires adjustment. Please note, since this is a manual submission, there will be a longer processing time than typical payroll. For more details, see our Help Center here: https://help.shiftmed.com/en/articles/5492131-issues-with-clocking-in-and-out
Name
*
First Name
Last Name
Your Phone Number
*
Facility Name
*
**Please only select a facility name from the dropdown**
Date of Shift
*
-
Month
-
Day
Year
Clock In Time
*
Hour Minutes
AM
PM
AM/PM Option
Break
Hour Minutes
AM
PM
AM/PM Option
Break Duration
Please Select
30 min break
1 hour break
No break taken
Clock Out Time
*
Hour Minutes
AM
PM
AM/PM Option
Guaranteed Shift
*
YES
NO
Reason for missed punch
*
Please Select
App Would Not Let Me Check-Out
Shift Not Available in the App
Time Correction Request
Connectivity Issues
Break Request
Detailed Reason for Missed Punch
*
Send to Shiftmed
Should be Empty: